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Medical Malpractice


Incapacitated Person - Idaho Department of Health and Welfare v. Jess C. Matey, 213 P. 3d 389 (Idaho 2009), the Supreme Court of Idaho misread Ahlborn to allow a State to seek reimbursement of past medical expenses from those portions of a recipient’s tort recovery intended to compensate for all medical expenses, including those portions of a recovery intended to compensate for past medical expenses paid by individuals or entities other than Medicaid, and those portions of a recovery intended to compensate for future medical expenses. Te poorly reasoned decision of the Idaho court in Matey served as the sole articulated basis for the Department’s insistence in my case that it was entitled to full reimbursement of its claim for past medical expenses even though the Recipient, my client, had recovered only one half the value of this aspect of her claim and half the value of every other aspect of her claim. Matey involved a young man who sustained serious,


permanent and disabling injuries in a car wreck. He agreed to accept the sum of $1,250,000 in settlement of his claim for personal injuries even though he actually incurred damages of $19,888,805.52. Te damages incurred by Matey were as follows:


Past Medical Expenses Paid By Medicaid $


Other Past Medical Expenses


its claims, the Department became increasingly unwilling to compromise to any extent throughout the spring and summer of 2009. While I understood the Department’s resistance to the Tristani arguments – which are yet being challenged on appeal – I was completely astonished by its refusal to honor the teachings of the Supreme Court’s decision in Ahlborn. In one case that settled for $2,800,000, approximately


one half its full value of $5,600,000, the Department took the position that it was entitled to reimbursement of $300,000, the full amount of past medical expenses incurred and paid on behalf of the Medicaid Recipient. In other words, the Department not only rejected the Recipient’s primary argument that the Department could not recover at all under rationale of Tristani, but it also steadfastly refused to consider a reduction of any size despite the clear teachings of Ahlborn. When pressed to articulate the rationale for its position, the Department stated that it did not feel bound by Tristani because it was but one decision out of one court. On the other hand, its stated rationale for refusing to consider any reduction in it subrogation interest was another single decision out of another court, specifically the Idaho Supreme Court.


In the Matter of Te Person of: Jess C. Matey, An 36 Trial Reporter / Summer 2010 $ Past Lost Earnings $ Future Lost Earnings $ Lost Household Services $ Future Medical Expenses $ 16,288,637.00 Capped Non Economic Damages $ 268,026.56 $ 19,888,805.52 Because Matey recovered only 6.285% of the total value


of his claim, he filed a petition seeking a determination that Idaho’s Medicaid reimbursement should be limited to a similar percentage of its claim for past medical expenses (6.285% of $60,752.74 or $3,818.26). Idaho did not dispute the amount of Matey’s actual damages, nor did Idaho dispute the proposed allocation of his recovery amongst the various damage claims. Nevertheless, Idaho claimed – and the Idaho Supreme Court held – that Idaho was entitled to full reimbursement of past medical assistance benefits because,


338,355.00 2,538,755.50 28, 685.00 345,562.74


Miscellaneous Medical Expenses paid by Matey $


30,031.18 $60,752.54


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